CENTRAL STERILE PROCESSING Our goal for the Central Sterile Processing Department is to create a stable and knowledgeable base for your staff members to meet your facility goal and provide a teaching program that can be managed “In - house”. We can achieve some major goals: Establish a base line of competence for members of your team as to the proper handling of and care of instrumentation. Establish facilitator competence to train, reinforce, monitor and correct any deviation from the proper handling and care of instrumentation. Advantage will provide the facilitators and management team with a synopsis for the program that we together can implement. The training program will empower you to add staff to the central sterile department by creating a functional staff team member. This is done by having minimal class room time; direct “hands on” training and documentation of competencies met, plus follow-up assessments by your educators and supervisors. We at Advantage Support Services truly have a commitment and passion for the instrumentation process and look forward to being a positive in your facility. With your leadership and commitment to follow through with the implementation of the central sterile training program, we can reach the goals that you want to reach for your customers, staff and patients. You can now have the tools in – house that will allow your facility to have a solid baseline of knowledge to achieve the goals for: instrumentation delivery, set completion and sterility. CENTRAL STERILE PROCESSING “ON - LINE” EDUCATION PROGRAM www.advantagesupportservices.com www.yourtrainingsite.com

What is the importance of education? Increases base knowledge “DISH WASHER” mentality to the “SCIENCE of STERILIZATION”. AAMI’s standards recommend certification Encourages accountability Have one standard practice 1.Education will increase the staff knowledge base to the correct guidelines of AAMI, AORN, CDC and OSHA. 2.Education will facilitate the confidence in the staff member to move from a “dishwasher mentality” to an understanding of the science they perform each day. 3. States have made it mandatory for and employee to work in the central processing department, the employee must be certified. AAMI recommends that the staff members achieve a certification level as well. 4. Staff and management can not have a measure of accountability, if the staff does not have the information to perform their tasks. 5. Increasing staff knowledge will drive the departments instrument process to have on standard practice. 2

What is so important about Standards of Practice? Allows Educators / Trainers: Additional Productivity Hours with on-line program easily accessed by technicians Staff is: Using the same language and processes Cross training Evaluate errors and omissions in the process All staff is using the same language and the same processes, on every shift including weekends. The staff is performing tasks, without deviation, from the standard process set. Staff is knowledgeable to other tasks performed by coworkers. This builds an accountability measure to each other as well as a sense of team work. This also allows for cross training. Having a standard of practice enables the management team as well as supervisors, on the floor, to evaluate and document errors and omissions during the instrument process. 3

GOAL - Reduction in Total Costs – (long term in the following areas): Instrumentation Damage and Loss Of Items Surgical Start Times Cost Containment with Surgical staff preparing for case starts Cost Containment with Infection Control Training dollars are reduced with accessibility of on-line training

What our department wants to accomplish Access to a developed program that will provide: Improve and correct challenges “Accountability” and “Ownership” Increase “Standard of Care” Product improvement for our customer Goals for instruments: Sterile On Time Complete Sets We would like to have a developed education program that will provide our department with the following: a. A process to improve and correct process challenges. b. We would like to create a sense of accountability and ownership with our staff members. c. We would like to improve the “Standard of Care” our patients. d. We would like to have access to a process that would improve the product we deliver to our customers. e. We would like to improve our process to reach higher goals set for the instrumentation process: a. Sterile Instruments b. Instruments delivered on time. c. Instrument sets complete. 5

Let us explore four different education paths and their costs Educate on our own – A facility / department developed program This path would challenge us to us our own resources. The management and training team would have to consider time constraints for manager and supervisor to develop a training program. This would include gathering information, develop teaching programs, develop a documentation process and implement the education program. This also means the department must get “buy-in” from infection control, the education department and management structure to allocate time and resources to create the program. The cost to create a program would be time and resources. 2. Self Taught This would be a self study program. The individual staff member would have to take personal ownership and responsibility for the education process. We at Advantage have experienced that usually this process of training has little to no direct impact for the improvement of department or instrument processes. Self taught does not usually impact co –workers to creates uniform care. There is no financial cost to the department, unless the facility reimburses staff for supplies and time invested. 3. Out source education to a consultant / educator to facilitate all training. The consultant would provide the department staff with all current standards of sterilization practices and with processing tools. The educator would be on site during staff shifts to lecture and proctor exams and to reinforce AAMI standards for processing instruments. The educator will create stability and a standard process, unfortunately it is short lived due to the fact of staff turnover and management “buy-in”. The financial cost usually exceeds the education budget for most central sterile departments. An outside consultant/ educator, on average, equals $12,000. 4. The best of all three paths would be an “In – House” training program provided by Advantage Support. The next slide will demonstrate what the “ In – House” program provides. Can we educate on our own? Can the staff members do it themselves? Should we hire an outside educator to be on –site? How can we get the best of all three? 6

“ON - LINE” TRAINING Objectives and Tools Standard of Care Uniform Care Facility controlled Current standards TOOLS Video demonstration On – Line System Workbook and Exams On – Line system On site “hands – on” demonstrations Customer Service The objectives of the “In – House” is to educate (facilitators) to standard of care through the information to produce a base line of uniform care for all staff on all shifts. The “In – House” training provides the department facilitator a program that the facility controls. The program includes education from AAMI and AORN guidelines, the CDC, and OSHA standards. Advantage Support will provide videoed lectures and demonstrations through an on line system. Also on the On – Line system we will provide staff with lectured material in the form of workbooks, exams (a passing grade at 70% or higher) and reports to the management team of staff participation and progress on a weekly basis. We coordinate with instrument and equipment manufacturer’s who will provide on site demonstrations to staff members. Advantage will be onsite to receive post demonstrations and access competency from facilitators, as well as educate facilitators “how to train” and “ how to receive post demonstrations” in the 5th week of the training program. Advantage Support will provide a customer service “hot – line” to support the facilitating team. These services are available for 1 year after the initial 5 week training program. This program provides your facilitators a complete training tool for all new hired staff, for existing staff and for the development of a preceptor ship program. 7

These are the disciplines lectured, demonstrated and tested: Professionalism Your Professional Role Introduction to Sterile Processing Decontamination Microbiology PPE OSHA and Universal Precautions Clean Room, MSDS, Eye wash Handwashing, Transporting, Receiving, Body Mechanics, Loading and Operation of Cart Washer Manual Inspection of Instruments Mechanical Wash Preparation / Packaging Instrumentation Receiving Items Inspection Process & Assembly of Dries, Sorts, Inspects for debris and function Count Sheets, Organizes Items accordingly Internal and External Indicators – Corresponding sterilization process and placement correct Missing Instrument Protocol Wrapping Trays Peel Packages Quality Assurance before release Care for Soiled Instrument Standard Free of Bioburden, Filter Inspected and In place Internal & External Indicator, Technician Initial Each class will include the following teaching methods: Lecture 1 hr per day scheduled via on line videoed lectures Train to each item Demonstration “on the floor” Post – Demonstration Testing of 70 % or higher Reporting to management of staff participation and progress on a weekly basis The program will consist of the following disciplines: Professionalism - Quality Assurance Practices - Decontamination - Preparation / Packaging - Basic Instrumentation knowledge – Sterilization Practices NOTE: Professionalism and Quality Assurances are integrated in each discipline of processing practices.

These are the disciplines lectured, demonstrated and tested: Operation and Practices of Sterilization for: Steam Gas Plasma EtO processes Documentation of sterilization records Loading Cart Wrapped Items and Peel packs vs. Containers Knowledge base for Pre-vac and Gravity for steam sterilization Monitors and Parameters Bowie – Dick test Biological, Placement, Designated Use, Incubation of, Documentation of Unloading and Safety Measures Recall Policies and Procedures

This “ON - LINE” training is designed for your organization IF: If facility has multiple shifts IF management team has no extra time If department needs documentation If department is committed to standard of care for patients If department needs a cost effective method to train staff Wants a science of sterilization mentality Uses several sterilization methods & specialized solutions Uses specialized surgical instrumentation Does not have a Central Sterile training school or program If staff struggles The “In – House” training program is designed for your department if: 1.Your hospital is moving from a “ dishwasher mentality” to a mentality that encourages growth in the sciences of sterilization. If your organization is uses multiple specialized sterilization practices and specialized solution to clean and decontaminate your instrumentation. If your organization uses specialized surgical instrumentation, including robotics and endoscopes. If the department does not have a Central Sterile school or education program. If your staff struggles with a self study program. If your organization process instrument on multiple shifts. If your department does not have a standard practice for all shift. If your management team does not have time to design a training program. If your department needs a defined process to document staff competencies or results for sterilization. If your organization is committed to creating a standard of care for the patient. If your organization desires a cost effective way to establish a training program that the facility controls. 10

“ON - LINE” Training Times and Uses Suggested Class Time - 5 weeks 6 hours per week for: Video demonstrations Video Lectures Work book lectures On line exams Remainder of training per week Provide hands on demonstrations / VENDORS Receive post demonstrations Provide reinforcement of process Documentation of competency Some suggested Uses for : Orientation Program for “New Staff” Aid in training existing staff to current AAMI guidelines Getting all staff on the “Same Page” Reinforces staff working toward certification Trains surgical staff to processes Suggested class times for facilitators to train staff is 24 hours per week. This 24 hours is divided to ensure that instrument productivity is still achieved. Three days per week, each day consisting of approximately 2 hours will be spent on – line to receive the videoed demonstrations, and to study the on line work book information as well as taking the on – line exams. The remainder of time spent in training during the week will be on the floor during the staff member scheduled shift. This training will consist of facilitators providing demonstrations and the staff members performing post – demonstrations for competency. The facilitator will reinforce all education on the floor during the staff members shift as well as provide documentation of competency to the management team. The suggested time of program will be 5 weeks. This will provide all staff on all shifts a standard of practice. It will also provide and orientation program for all new hired staff. 11

Summary “ON - LINE” TRAINING Importance of education Increases base knowledge to the “SCIENCE of STERILIZATION Standards of Practice Staff is using the same language and processes Management team can evaluate errors Department wants instruments: Sterile On Time Complete Sets “ON - LINE” TRAINING Increase Standard of Care Create uniform Care Facility controlled Training Provides: Video demonstrations Work book lectures On line exams Demonstrations and post demonstrations Reinforcement of process Documentation of competency